Provider Demographics
NPI:1437108644
Name:GUNTER PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:GUNTER PHYSICAL THERAPY LLC
Other - Org Name:SCOTT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:337-769-1556
Mailing Address - Street 1:PO BOX 61651
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-1651
Mailing Address - Country:US
Mailing Address - Phone:337-412-6146
Mailing Address - Fax:337-504-2884
Practice Address - Street 1:101 PARK WEST DR
Practice Address - Street 2:SUITE B
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-8902
Practice Address - Country:US
Practice Address - Phone:337-769-1556
Practice Address - Fax:337-769-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CQ69Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION #